Baby Born to Brain-Dead Woman with Melanoma

Action Points

Point out to interested patients that a fetus born at 21 weeks will not survive. Survival rates jump from 10% at 23 weeks to 50% for fetuses born at 24 weeks.

Infants born at 24 weeks face immense lifelong disability. Neonates born at 24 weeks are likely to have vision, hearing, and feeding problems, intracranial bleeding, respiratory distress syndrome, and are at high risk for neurological disorders, such as cerebral palsy.

ARLINGTON, Va., Aug. 3-After nearly three months on life support, Susan Torres, a brain-dead woman suffering from metastatic melanoma, gave birth to a baby girl yesterday.

The baby, Susan Anne Catherine Torres, was delivered by Caesarean section at 28 weeksâ€™ gestation. She weighed one pound, 13 ounces and was 13.5 inches long.

Babies at this gestation are classified as â€œextremely preterm.â€ Babies born at 26 weeks face a 60% chance of lifelong disability. Babies born at 31 weeks have a 30% chance of disability.

There was no immediate word on the babyâ€™s condition. There had been concern that the stage IV disease might cross the placenta. The day after the birth, life support was removed and the 26-year-old mother was pronounced dead.

Lynn Schuchter, M.D., an oncologist and associate professor at the University of Pennsylvania, who specializes in melanoma, said in an interview that metastatic melanoma has been known to cross the placenta and affect the fetus.

There have been cases of babies born with melanoma to women with stage IV disease, said Dr. Schuchter, who is not connected to the Torres case. These babies die, she added.

In the rare cases of babies born to women with metastatic melanoma, said Dr. Schuchter, a pathological examination of the placenta is performed. Even if melanoma cells are not found, the children are monitored, and the malignancy, if present, will manifest itself within months, she said.

Torres collapsed on May 7 after complaining about headaches and nausea. Hospital physicians discovered a melanoma, treated nine years earlier, had recurred and metastasized to her brain. The tumor then hemorrhaged, causing brain death.

The mother of a two-year-old son, Torres was working as a researcher at the National Institutes of Health when she learned in February she was pregnant. Since the melanoma diagnosis when she was 17, doctors had assured her she was cancer-free.

What isn't known is how deep her melanoma was during her teenage years, said Sharon Hymes, M.D., an associate professor of dermatology at M.D. Anderson Cancer Center in Houston. When melanoma is confined to the epidermis, the risk of metastases is minimal, she pointed out.

Why doctors did not detect the melanoma's return is unclear. "It is not common to have metastasized melanoma this far out," said Dr. Hymes.

The timing of the possible spread to the placenta had been uncertain. "It's very rare to have placental metastasis, but if you had to pick a tumor that would do this, melanoma would be the tumor that would do this kind of rare thing," Dr. Hymes said. And, she noted, Stage IV disease is systemic.

Physicians had been watching the clock to give the fetus as much time to develop as possible while hoping to protect it from cancer.

Frank Boehm, M.D., a professor of obstetrics and gynecology at Vanderbilt University in Nashville, Tenn., a specialist in high-risk pregnancies, said the chances of survival improves dramatically if mother and baby make it to 23 to 24 weeks.

"The biggest change is at 23 to 24 weeks when you go from 10% survival to 50% survival," Dr. Boehm said in an interview. "Every day counts."

According to a report published by the University of Connecticut Health Center, there have been 11 similar cases since the 1970s in the United States where brain-dead women were kept alive to save the pregnancy, The Washington Post reported. The pregnancies were prolonged an average of 10 weeks, it said.

If the child had been born at 20 weeks it would have no chance of survival at all, Boehm said. Even with the 50-50 odds of survival at 24 weeks, the infant faces immense lifelong disabilities after birth, including respiratory distress syndrome, infection, vision, hearing, and feeding problems, and even intracranial bleeding. The child is also at risk for severe neurological complications including cerebral palsy.

If the baby had been born at 25 weeks, odds of survival would have jumped to 70%, Dr. Boehm said. Twenty-eight weeks gestation means a 90% chance of survival. Increasing maturity of the lungs, he explained, contributes significantly to these spikes in survival rates. Survival increases to 95% at 30 weeks.

Reviewed by Zalman S. Agus, MD Emeritus Professor at the University of Pennsylvania School of Medicine